Month: December 2024

Happy Frickin New Year! Here’s to a fresh start!

I have decided that tonight is going to be my best New Years in years. Am I going to be out drunk and ridiculous and unsafe? NO. Am I going to go party with friends? NO. But, I will be at home, eating fresh home cooked seafood with my husband and my cacophony of dogs and dog noise and dancing ridiculously to horrible 80s and 90s music with heavy bass and actually intelligible lyrics! Whooo!

Sounds boring? Well, I disagree. I have done a lot this year, all of it hard. I fought brain cancer. I fought my way back to consciousness after a coma. I managed to keep my business afloat and make sure all my employees were taken care of. I managed to begin digging myself out of the financial hole I was drifting and sinking down in with all the crazy stuff going on.

So, a little down time, me time, husband time and dog time sounds like just the perfect, normal and enjoyable thing. My positivity is soaring so high despite everything that I think it was literally reaching people even at McDonalds today when they gave me free food for a mistake that they did not actually make! Score!

So, everyone, I say have fun out there. Please be safe. Please savor life to the fullest. Have a good time and don’t do anything you will regret for longer than say 24 hours. Happy New Year everyone!

Dr. Katz

No news is good news!

I hear this cheerful sentence from the vet and doctor’s offices all the time. They say it with a smile as if you are supposed to find it amazing and reassuring if you do not hear from them. You are supposed to rejoice at the lack of bad news, or any news whatsoever.

You know what I hear when they say that? I don’t need to take the time to reach out to you personally to let you know that you are ok. I have just saved myself a ton of time in my busy day. Nothing about this statement lets me know that they are actually concerned about me or my pet, or that I can actually be sure that they didn’t miss something and forgot to call? That could happen too ya know. How long do I wait before I know it really is no news is good news? Are we sure after a week, two weeks, a month? See where I am going with this?

You see, at my office we call, or if we can’t get through, we text or leave a message about every darn thing, good, bad, ugly, sideways, or fantastic. That way we almost eliminate the chance of missing anything and the patient or customer has no question in their minds that they are worth our time and investment in their care. So, what if the majority of the calls are just to say that something is normal. Awesome! Then you are also making sure that you are giving yourself little to no chance of missing the few abnormal or bad news ones. To me it’s a no brainer. Inform everyone about everything. You tend to miss less this way and it shows that you give a crap. Ok diatribe over for now. Have a great day everybody.

Dr. Katz

Look How Far We’ve Come!

My husband and I have just celebrated 31 years together, 25 of them legal! Yes, that means that we just had our 25th wedding anniversary. We got to spend it in New Orleans with all kinds of food, ghost, voodoo, music, and fun. It was a wonderful time. I felt so fortunate that we got to spend it together, just the two of us. It had been several years since one or the other of us were sick and could not enjoy each other on our anniversary for one reason or another. This year was truly a blessing.

I started thinking back about how far we’ve come. I first met my husband in medical school. How he first drew my attention was the fact that he was literally the guy that laughed 30 seconds longer than anyone else in the entire lecture auditorium, loudly and with vigor. To the point that you were kind of shrinking down in your seat and hunching your shoulder with embarrassment, even though you weren’t the one doing the laughing…Oh lord. He also wore leisure suites fresh out the 70s every single day to school. Um what?! I gotta say, that was unique if nothing else.

So, we weren’t actually friends or hung out in any way and then one day, he invites himself to a concert with me and a friend of mine. I am ashamed to say that we actually refused to pick him up at his apartment because he lived in a part of Detroit that we were scared of at at the time (this was back in the 90s, not Detroit as we know it now). Well, he was un-fased and actually drove an hour way to meet us up at a dance club in his broke-ass, bungie cord hatchback attached Sunbird SE to meet us! We ended up dancing the night away. He had the whole club heying and hoing in a matter of 20 minutes! He complimented my absolutely horrible outfit…with sincerity! We ended up going back to my house together and he looked with rapt attention at my ridiculous post card collection and ate my parents terrible food and we talked til dawn, just like a movie. Honest to gosh.

Now, here we are 31 years later. Still happy and thriving. We have mounted the sometimes un-seemingly recoverable obstacles and tragedies and kept on going. We are both independent physicians and take care of people of all ages every day. We laugh until we almost pee our pants. We like the same ridiculous jokes. We watch chick flicks together. We are parents to three beautiful girls, who feel more like 6 any given day. I’m telling ya, we got it going on. You just never know what joy you could end up with if you give things a chance.

Dr. Katz

Sitting here quietly

Just sitting here quietly on Christmas morning, listening to my gentle music Christmas blend, snuggling with my dogs. I am taking a moment to soak it all in. It just dawned on me this is the first Christmas in like three years that I am not either waiting for a terrible health diagnosis or in between cancers. Wow! That just hit me like a soothing wave of calm, mixed with excitement and relaxation in the mundane all at the same time. Yesterday I was doing my regular old last minute Christmas eve grocery shopping and I couldn’t have been happier. The business, the franticness of the other customers didn’t even phase me. I was so frickin happy to be shopping for my family like a normal wife and mother that I think I was practically skipping through the store. I know it sounds silly, but gosh I have been waiting for this feeling for a long time now. I am finally allowing myself to enjoy it, now seven months after discharge from my last hospital stay.

I know I am just really heady right now but I am soaking it up. Everyone deserves this kind of peace, even if just for a moment. Who knows if everything could revert back to unholy crap. Well, maybe it could. That’s how life goes. But, for now, I will just sit here with a smile on my face and let it sink in.

Have a wonderful holiday everyone! Sending many peaceful and joyous vibes.

Dr. Katz

At least I had a tangible enemy

Ok brace yourself. I am going to say something that is initially going to sound a little crazy, but just bear with me. I actually consider myself lucky that cancer was my battle to fight. I know a ton of people right now going through things with as yet discovered causes and no specific direction or plan. It is an awful way to exist. The discomfort, the suffering, the lack of answers, the whole nine yards. The fear of the unknown is a real thing. I think it literally is an impediment to healing.

I am hear to tell ya, that my cancer was no picnic. To say that I am lucky sounds ridiculous to say. I get it that I am not lucky that I had cancer, twice in two years. Yes I know. What I mean to say more purposefully is that at least my demon was described and known and right in front of me, allowing me to have a definite target to tackle. It was terrifying for sure, but at least I had the privilege of knowing what I was fighting. It intensified my focus and enhanced my hope that there might be an end to the tunnel. Everybody I know right now that is battling does not have a set enemy in sight and no specific plan. Bottom line, I am sending out the discovery and healing vibes out to everyone I know that is battling right now. I am here if you need me. I am here to help strategize. I am here to help if you want me to.

Dr. Katz

Endometriosis…it’s a real beast and should not be ignored!

Ok ladies, let’s talk about endometriosis. First of all, what is it and why should we care? For those of you lucky ones who don’t know. Endometriosis is a disease where implants of endometrial tissue set up shop all over the body, especially the pelvis and cause pain and painful and heavy periods. For most of us, while most of that endometrial lining sheds out our vaginas during our periods, some of it backwashes up through the fallopian tubes into the pelvis, where nothing happens and it just shrivels up and disappears. In the right unfortunate person, those implants set up shop wherever they want and the havoc ensues. Did you know, that endometriosis behaves almost like a cancer? It can travel through the bloodstream and end up anywhere? We don’t call it cancer because it does not kill you, but it is just as awful. I have even seen endometriosis in brains and lungs! What the hell?!!!

So, how common is it? At first glance, the stats say that it can affect one in ten women. It doesn’t sound like much at first, but when you elevate that to a global level and take into account every country and continent, that amounts to about 190 million reproductive age women who are affected at any one time! Ok, that is a crap ton.

How do you diagnose endometriosis? I have people coming in to see me all the time saying that they know that they have endometriosis and that their doctor told them. I then ask them how they know and what tests that they have had. Most of the time, they haven’t had any or they had one usn and were told that endometriosis was seen on that. AAAAANGH. I am pressing the no buzzer on that one. Besides the instance when you have some gigantic ovarian tumor cluster of endometriosis, you cannot see anything on an ultrasound so that is just not true. The only absolute way to diagnosis endometriosis would be to have a positive biopsy of a lesion or the peritoneum. The other way is to visualize lesions on a laparoscopy. The other possible way is to get a really expensive mri of the pelvis that could possibly see possible lesions that could possibly be endometriosis…or something else. On top of that, sometimes when you do get a biopsy of what appears to be normal appearing peritoneum, 20 percent of the time it could be endometriosis hiding underneath. It is a really sneaky bugger. The realy key is a tissue diagnosis but if I see a bunch of visible classic lesions on laparoscopy, I am going to go for it and treat it.

So, what can we do about it? The ultimate goal in treating endometriosis is removing its hormone food source. That’s right you guessed it ladies. The ovaries themselves provide its main food source. This means that the ultimate permanent treatment for endometriosis is to remove everything: the uterus, cervix, the tubes, and the ovaries. You can also ablate lesions individually or resect them. But, it is practically impossible to remove them completely forever. This usually means a significant surgery with a significant scar and significant down time. On top of that, you are thrown into instant surgical menopause overnight instead of the 6 months to 2 years that it normally takes. Bring on the hot flashes, night sweats, increased farting and bone loss…overnight! Yikes! But at least then it is gone for good, usually about at 6 months after surgery when the last of the hormones have washed out of the system and the microscopic implants that you could not see have resolved.

Now, we have some medical options as well. The old standard was Lupron, an injectable, every month to every three months GnRH analog that shuts down hormone production and puts the patient into medically induced menopause. It can be used for a maximum of 6 to 12 months and maybe can be repeated later if symptoms reoccur. It is expensive and the side effects are kind of awful. We now have more modern oral meds like Orilissa(elagolix) and Myfembree(relugolix). Orilissa is a GnRH antagonist like an oral version of lupron. It also has a bunch of side effects and is not recommend to use beyond 2 years. Myfembree is also an oral med which has some estradiol and norethindrone in it so the menopause side effects are less while still being able to control the endometriosis. It can also be used up to 24 months. It was originally invented to treat fibroids but I have found that it is pretty successful for endometriosis too. Both are costly and you have to jump through multiple hoops and hurdles to get them covered. But, when they work, they can be a real bonus for the patient.

Bottom line is, endometriosis completely sucks, but now there is more than one option out there. Make sure you seek out a physician who is willing to put the time in to help improve your quality of life and help treat the endometriosis in the best way possible and treat you like an individual and be mindful of your particular goals. If you can’t find one near you, come see me. I got ya covered.

Dr. Katz

No, it’s not ok that your vagina hurts and no, you don’t have to just accept it as a part of the natural course of aging….the vagina manifesto!

Oh lord, people. I hear this from patients all the time. They have been in pain and discomfort, sometimes for years, to the point that they can no longer enjoy any part of an intimate relationship or ever feel comfortable in the hinterlands. I am now understanding that this is being told to women by both male and female physicians. What the? I can sort of see it coming from male physicians because they have no personal perspective to relate to but female physicians saying this too? Shame on you ladies! You know better. I am willing to bet that you are just not willling to spend the time dealing with it. I am not sure why though.

Well, I am here to tell you that you don’t have to just accept that….from any physician. Is it true that our vaginas become drier with age? Well, yes they do, but there in fact is all kinds of stuff we can do about it! It is not just something you have to deal with and suffer. I am hollering bullshit over hear when I hear that.

I know we are always going around telling ourselves that sex isn’t everything and it is not the key to a relationship. I am not saying it is either, but we are kidding ourselves if we think that depriving ourselves of that level of intimacy with a person that we really care about, or lust after as the case may be..lol has no consequences.

So, let’ s first talk about why the vagina changes so much as we age. It is time now to bring out the hormone blame. As the hormone levels drop or lose their equilibrium, the vaginal tissue becomes thinner, more friable, more delicate, looser, and unable to self-lubricate. The PH also gets off and leads to increase risk of infections. In fact, the angle of the vagina also changes to the point that hitting that magic g spot becomes almost impossible at times. On top of that, as our testosterone levels drop as well, our libido goes down the toilet. How’s that for abject chicanery? We are dry, we hurt, we don’t want to do it in the first place or we don’t want to do it because we know it will hurt.

I have good news coming! All of this can be addressed and the pain can resolve and the pleasurable sexual functioning can be restored! There are all kinds of creative and safe options that can be individually tailored to the specific woman.

First let’s address the dryness. I said that the vagina gets thinned out and irritated right? So, we need ways to plump it up and relubricate it. I have several. One is to do it with hormones, either orally or directly into the vagina. Usually estrogen is the key here and testosterone too.This is a potentially awesome option with relatively quick positive effects. There are several things to consider before entertaining this option though. You have to know your patient’s entire history. Women are not a candidate for these hormonal options if they have a history of certain cancers or blood clots. Women who have these conditions are not a candidate for hormonal therapy. Also, you have to keep in mind that if they still have their uterus, you cannot give them estrogen only because it could overstimulate the uterus and potentially lead to endometrial hyperplasia or cancer. But, no problem there, just balance it with some progesterone too and you are all good.

The good news is that there are plenty of alternatives for the patients that cannot take hormones. You wouldn’t think of this first but regular fresh out of the kitchen extra virgin olive oil is an excellent lubricant. So is coconut oil. My personal favorite is olive oil because you need less of it and it tends to be less greasy and get everywhere. All of those amazing feminine lubrication products out there tend to be the devil in my opinion. If you read the fine print there, there are all kinds of those things in those products that actually irritate the vagina more than they lubricate it. All that scented stuff that makes us think we have to smell like flowers, cake or pie? I say run in the other direction. The vagina has it’s own smell and no one is going to swoon away by letting it have its own natural odor. But, I have to admit that the packaging is very attractive. They also tend to be expensive too. I say forget it and just go with the olive oil or the coconut oil. Or, at least pick a water-based lubricant like astroglide. It seems to be the safest.

I have another good option for those that cannot do hormone therapy, the forma V intimate rejuvenation treatment. It is a radiofrequency treatment that involves inserting a wand into the vagina multiple times for a ten minute or so, in-office treatment, that replumps the vaginal tissue, relubricates the vaginal tissue, tightens the muscles, resets the vaginal angle and tightens the skin as well. It has no significant risks. You can even get it done if you have had a history of cancer or a previous sling or anything like that. We are using this awesome procedure lately to even return 80 plus year old patients back to the bedroom. There really has been no significant discomfort with this procedure so far in the last several years of doing it besides some pressure at the time of treatment only. The catch is that insurance does not cover it so there is an upfront charge, but every patient I have treated with this procedure has thought it was very effective.

There are other reasons to develop vaginal and vulvar pain as well. The most concerning ones are something called vulvodynia with or without vaginismus. Vulvodynia is a condition when there develops certain pain trigger points around the clitoral hood, around the urethral opening or at the bottom entrances (the vestibule) of the vagina. This trigger points become so inflamed that any attempt at penetration causes an extreme pain response. This can sometimes lead to an intense spasm of the muscles called vaginismus. Sometimes you get lucky and can determine a specific lesion or area of irritated skin that is causing the pain and you can treat that and the pain goes away. More often that not, there are just these trigger points with no set lesion. If this is the case, temporarily treat these areas with topical hormone cream for a month or so and then convert to a long-term topical combination anti-spasm, analgesia, anti-pain medication that the patient may have to use daily for the rest of her life. But these options do really work well and can even help return these patients to an intimate relationship. The other thing i do with these patients is that we take a deep dive into their cleansing regimens and use of certain detergents, soaps, and toilet paper and make any changes to their routine that could be contributing to any inflammation or irritation. I call it my be kind to your vulva tip sheet. You would be surprised at how many things you could be doing to harm yourself without realizing it.

Let’s talk lastly about libido and its relationship to intimate relationships. If you have no desire to have sex because you are afraid it is going to hurt, then you treat as above and once you eliminate the fear of pain, libido will usually return. If your lack of libido is due to a testosterone deficiency, you can either treat with oral micronized testosterone or local vaginal testosterone with great results. If you are not a candidate for hormone therapy, there are a variety of excellent herbal alternatives like schizandra or argin max or even yohimbe that can be very helpful.

The bottom line is that all is not lost. Ask for help. Seek a physician who is actually willing to take the time to get to the bottom of your particular issues. It will be worth it. The bedroom is calling!

Dr. Katz

Let’s Talk Therapy

Did you know that about 50 percent, if not more, of cancer patients/warriors/survivors have some form of ptsd? Ptsd stands for post-traumatic stress disorder. Ptsd occurs when someone has experienced or witnessed a shocking, scary, terrifying, traumatic, or dangerous event. This leads them to over respond to any sort of trauma from thereafter in an often debilitating or exaggerated way and could affect the rest of their life. It is a terrible condition. Therapy is an absolute must to try to combat this condition.

As a two-time cancer patient, I can tell ya, this crap is real. It can be devastating, debilitating and down right crappy. You find yourself freaking out at the slightest twinge, expecting the worst and not even considering the best. You have a scan coming up and find yourself grabbing for the ativan just to make it through it. It can get pretty ridiculous. Logic tells you that everything will likely be fine, but it is tough to believe it because your past experiences have taught you otherwise.

Ok, it sounds awful right? Heart pounding, sweating, pulse racing, fear coursing through your veins, ibs gettin all crazy. But, here’s the good news. There really is help out there, if you are willing to pursue it. You do not have to remain a prisoner of this terrible thing. That option is therapy. I mean actual, dig deep, deal with your demons, full disclosure psychological therapy. As difficult as it is, it can help you deal with your demons and identify your triggers and develop strategies that can either help you deal with these episodes when they happen or prevent them from happening in the first place. It’s truly a possibility of all wins.

The bottom line is that if you really want to start living after fighting your toughest enemy ever, you have to deal with the leftovers. You just have to, or else the fight won’t seem worth it in the first place.

On that note, I’m off to my regularly scheduled therapy appt. Peaceful vibes and power wishes.

Dr. Katz